title: Randomized clinical trial of arginine-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing gastric cancer surgery.
abstract: OBJECTIVE
  Significant malnutrition exists in a high percentage of patients with gastric cancer. It is, therefore, crucial to establish an effective means to provide nutrition for these patients. This prospective, randomized, double-blinded clinical trial aims to assess the long-term survival of arginine-supplementation enteral nutrition versus standard enteral nutrition in malnourished patients with gastric cancer.
  
  
  METHODS
  The control group (36 cases) received postoperative standard enteral nutrition. Meanwhile, the arginine-supplementation group (37 cases) adopted the same nutrition product but enriched with arginine (9.0 g/L). The primary study objective was overall survival (OS). Secondary endpoints were progression-free survival (PFS); serum parameters including total protein, albumin, proalbumin, and transferrin obtained on preoperative day 1, postoperative day 2, and day 12; CD4(+) and CD8(+) T cells, natural killer (NK) cells, immunoglobulin M (IgM), and immunoglobulin G (IgG) obtained on preoperative day 1 and postoperative day 7.
  
  
  RESULTS
  No significant differences in baseline characteristics were observed between groups. The group receiving arginine-enriched nutrition had a significantly better OS (P = 0.03, 41 vs. 30.5 months) and better PFS (P = 0.02, 18 vs. 11.5 months). On postoperative day 7, CD4(+) T cells, NK cells, IgM and IgG levels of the arginine-supplemented group increased prominently and were significantly higher than those of the control group and those on preoperative day 1. There is no significant difference in the serum total protein, albumin, proalbumin, and transferrin levels between the two arms.
  
  
  CONCLUSIONS
  Arginine-supplemented enteral nutrition significantly improves long-term survival and restores immunity in malnourished gastric cancer.
authors.affiliation: Department of Intensive Care Unit, Daqing Oilfield General Hospital, Daqing, 163001, China.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Zhao
authors.forename: Hongying
authors.initials: H
authors.lastname: Zhao
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Huang
authors.initials: H
authors.lastname: Jing
authors.forename: Qian
authors.initials: Q
authors.lastname: Ding
authors.forename: Jun
authors.initials: J
authors.lastname: Xue
mesh_terms: D000328:Adult; D000368:Aged; D001120:Arginine / Q000008:administration & dosage*; D019587:Dietary Supplements; D004311:Double-Blind Method; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000178:diet therapy* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate
chemical_list: D001120:Arginine